We’ve heard this a lot lately during midwifery consultations, especially from first time parents who are still exploring their options and aren’t totally sure what they are looking for in a provider. Many people know that the Midwifery Model of Care is different from standard hospital care, but aren’t certain if this means that all midwives are pretty much the same or if there is more they might need to know in order to select a provider that they can trust.
There are some standard questions that you should be asking ANY care provider (midwife or not). Things like:
“What is your cesarean section rate?”
“How do you approach the use of tools and interventions in the labor process? What is your philosophy on this?”
“What are your routine newborn procedures immediately following the birth (skin to skin, delayed cord clamping, newborn exam etc)?”
These are awesome questions to ask and a big part of what we talk about during our consults!
BUT there are also some midwife-specific questions that are super helpful and may help you narrow down your search so that you can be sure of selecting a midwife and practice that is a good fit for you:
Do you practice as a solo midwife or in a team? How does that work?
For example, some midwifery practices (like ours) work with two midwives at each birth, while others use a solo midwife with a qualified assistant. Find out what happens if the midwife(s) you have hired are occupied at others births when you go into labor. What/who is the backup care provider in this scenario?
How long have you been a midwife? In what kinds of settings have you practiced?
This gives you a great feel for the length and breadth of experience your midwife has had! A midwife who has been practicing for a long time, but with a very low volume of births is not necessarily more experienced than a midwife who has been practicing for a few years but in high volume settings. Pick the midwife whose experience seems the most relevant to your situation!
What kind of training did you receive to become a midwife? How long did it last?
This gives you a great feel for how much knowledge and foundation your midwife has at the art and science of midwifery. There are many different paths to midwifery including: traditional apprenticeship/experience focused education, self study pathways, formal degree and academic education pathways, nurse to midwife pathways etc. Find out what path your midwife chose and why! Each one has different strengths and weaknesses and it’s good to know which type of midwife you are selecting!
Why did you become a midwife?
I can pretty much guarantee that no one got into midwifery for the money. Or even stable income. So find out what the draw was for your particular midwife! Many midwives have stories about their first experiences with birth and midwifery and why they felt the pull toward this particular profession. Learning about this “origin story” can give you insight into the values and goals your midwife has, and these will definitely affluence her practice style!
Do you have experience working with clients like me?
For example, has this midwife worked with people of your particular culture, ethnicity, religion, family structure, sexuality, health concerns, trauma background, or other unique situation? If so - do they enjoy working with folks in this type of situation? Ask them why! This can speak volumes when it comes to selecting the care provider that is right for you, so don’t be shy to ask the big questions that will impact your pregnancy and birth. A midwife who is inexperienced in your situation isn’t always a bad thing. In fact, it can mean that she will do extra research and advocacy on your behalf (an awesome resource to have in your corner). But it’s definitely important for you to know in advance.
How do you prefer to communicate with your clients?
Find our how much communication your midwife usually has with her clients! Does she text? Use an online portal? Does she prefer phone calls or emails? Do you have access to her outside of appointment times? Most midwives are easily accessible when something serious is going on (i.e. labor, bleeding etc), but what about those lesser concerns (like what brand of supplement to take, muscle strains in pregnancy, type of pads to get for postpartum etc). Find out how she prefers to talk about these things!
What is your philosophy on doula support during labor?
I feel like this is a super telling question for midwives! It allows them to explain the kind of care they provide and explain the different skills that a doula might be able offer you. If your midwife doesn’t feel that doulas are important or valuable in addition to midwifery care it can mean that they either:
1. Have a very hands-on approach to labor, and plan to be very invested in providing physical and emotional comfort as well as medical care or
2. Do not like feeling challenged by the presence of another support person or care provider who may witness their care, disagree with them, or offer you alternative suggestions. This might be a red flag!
What is your episiotomy rate?
I wish I could say that midwives never cut episiotomies. I wish I could say they were never necessary. But sometimes they are! The important thing here is not to accept the pat answer of “it’s very low” or “we only do it in case of emergencies.” Both of these may be true - but there are no standardized guidelines on when an episiotomy is actually indicated (it varies by provider and relies largely on their gut feeling during the birth on whether or not it’s necessary). So find out how often your midwife gets that gut feeling and believes it to be necessary! If they aren’t sure, this might be a red flag - and it’s totally appropriate to ask them to look through their records and get back you you!
What kinds of medications or tools do you have access to in case of an emergency? What kinds of trainings did you have to take to become competent in using these tools?
Some midwifery practices lean more toward the use of traditional/herbal practices when managing labor complications, while others lean more toward the use of modern pharmaceuticals and labor interventions. Many midwifery practices (like ours!) fall somewhere in the middle, with their own unique blend of traditional midwife art and modern medicine. Find out what tools your midwife prefers, has available and is trained to use.
What interventions/treatments/tools do you NOT use or have available?
All midwifery practices will have to transfer you to an OB for high-level care (such as surgery for a cesarean section), but some midwifery practices choose not to use certain interventions that other practices may have no problems utilizing if necessary. For example: Pitocin or other medications in case of hemorrhage, suturing, in-house lab work, hearing screening etc. Every practice is unique! Ask about the specific things that they do NOT offer or have access to, and how they would manage the situation if the need arises.
What is your transfer rate during labor?
How often do people need to transition to the hospital? This is an important question! And the answer will vary year to year, since most midwifery practices are not very large. Find out what their statistics for the last year or two have been. The research and literature shows that the overall transfer rate for out of hospital birth ranges from 9-13%. The vast majority of these transfers are NOT emergencies. On any given year a typical midwifery practice rate will be in the 10-15% range. If a practice has a greater than 20% transfer rate, it may mean that this practice is especially conservative in risking people out for home or birth center birth. This is good information to know!
What is your protocol for non-emergency transfers to the hospital? For emergency transfers?
Find out how this process looks different in an emergent versus non-emergent situation. Does the midwife go with you to the hospital? Do they stay or does an assistant stay with you? What does follow up care look like? This is great information to know when selecting a midwifery practice, and it will also give you a sense of how your midwife will approach emotionally/physically intense situations with you in labor. Is she dismissive of your concerns? Is she confident? Can she give you specific data or research to back up her claims? Does she answer your question or deflect?
What hospitals/care providers have you had positive experiences with?
If your midwife cannot list any hospitals or care providers in the area she has had a positive experience with - it may be a red flag that your midwife is not in good standing with the medical or care-provider community. While midwives have NO CONTROL how the hospital staff treat their patients, transfer experiences are often much better when the care providers have developed a trusting relationship and have previously worked together well.
Do you have references?
While important, this can be a tough one for midwives to answer while also maintaining client privacy. Look at your midwife’s social media accounts and google reviews for some of the experiences that previous clients have had. You can also ask for professional references (such as other community midwives or care providers) who can speak to the type of care your midwife provides! Often, these care providers can provide you with more specific questions to ask if necessary to make sure you are fully informed!
What “extra” or surprise costs might we encounter while in your care?
While most midwives have “global fee” which includes the cost of their services, sometimes there will be additional costs for medications, birth kit, ultrasounds, lab fees, lactation appointments etc. Find out what might cost extra so that you aren’t surprised when these costs pop up!
